Nonmedical use of prescription ADHD stimulants and preexisting patterns of drug abuse.

Multidrug use is well documented among nonmedical users of prescription stimulants. We sought to provide insight into the drug use patterns of those reporting nonmedical use of prescription attention-deficit hyperactivity disorder (ADHD) stimulants in an attempt to discern whether such use is a first step in a pattern of drug-abusing behavior or, conversely, is a later development accompanied or preceded by a history of drug abuse. A cross-sectional, population-based survey of the U.S. civilian, non-institutionalized population aged 12 years and older was analyzed for lifetime nonmedical use of prescription ADHD stimulants, lifetime nonmedical use of another prescription drug, illicit drug use, and drug use initiation patterns. This included 443,041 respondents from the 2002-2009 National Survey on Drug Use and Health. Lifetime nonmedical use of prescription ADHD stimulants was reported by 3.4% of those aged 12 years and older. Of these, 95.3% also reported use of an illicit drug (i.e., marijuana, cocaine/crack, heroin, hallucinogens, inhalants) or nonmedical use of another prescription drug (i.e., tranquilizers, pain relievers, or sedatives), and such use preceded nonmedical use of prescription ADHD stimulants in 77.6% of cases. On average, 2.40 drugs were used prior to the first nonmedical use of prescription ADHD stimulants. These data suggest that nonmedical use of prescription ADHD stimulants is not commonly an initiating factor leading to the nonmedical use of other prescription medications or abuse of illicit drugs. Rather, nonmedical use of prescription ADHD stimulants appears to be adopted by individuals already engaged in broader patterns of drug abuse and misuse.

Self-reported weight loss practices among African American and Hispanic adults in the United States.

OBJECTIVE: To describe weight loss methods used and interactions with health care professionals on the issue of weight among African Americans and Hispanics. METHODS: Five hundred thirty-seven African American and 526 Hispanic adults who self-described as being overweight participated in a telephone interview. RESULTS: Exercise and healthy eating were the 2 most commonly used weight loss methods among both groups; prescription medications were the least-utilized weight loss aid. Forty-one percent of African Americans and 35% of Hispanics reported having been advised to lose weight by a health care professional. CONCLUSIONS: Do-it-yourself approaches to weight loss predominate among African Americans and Hispanics; formal assistance is rarely used. Physician advice on weight loss is suboptimal.

Weight management advice: what do doctors recommend to their patients?

OBJECTIVE: To examine the weight management interventions that a broad population of adults reported receiving from physicians and assess what drug-related and behavioral information physicians provided when they prescribe weight loss medications. METHODS: A random-digit dialed telephone survey was conducted in 2005-2006 with a representative sample of 3,500 American adults. RESULTS: The most frequently reported interventions were having a doctor tell them about the health problems associated with being overweight (48.0%), or suggesting diet and exercise (46.5%). Few respondents reported having been referred to a formal diet program (5.2%), prescribed a weight loss medication (4.0%), recommended a non-prescription weight loss product (1.8%), or recommended stomach bypass surgery (1.5%). The proportion of individuals who reported each intervention increased across levels of body mass index (p<0.001). Of those who reported being prescribed a weight loss medication (n=155), only 29.5% (n=44) reported receiving all six counseling interventions that were assessed. CONCLUSIONS: Many overweight patients have not been advised to lose weight, diet, or exercise, and physicians have been particularly reluctant to recommend medications. When physicians do prescribe medications, appropriate counseling too often fails to accompany the prescription. Efforts are needed to increase the involvement of physicians in guiding patients to effective weight management approaches.

Relationship between adherence to daily nicotine patch use and treatment efficacy: secondary analysis of a 10-week randomized, double-blind, placebo-controlled clinical trial simulating over-the-counter use in adult smokers.

BACKGROUND: It has been reported that the efficacy of acute forms of nicotine replacement therapy, such as nicotine gum and lozenges, improves when sufficient quantities of medication are used. OBJECTIVE: This analysis examined whether adherence with daily nicotine patch wear was associated with improved rates of smoking abstinence. METHODS: This was a secondary analysis of data from a double-blind study in which subjects were randomized to receive either an active nicotine patch or a placebo patch under simulated over-the-counter conditions. Subjects were asked to complete a daily diary on their patch use and smoking. Logistic regression, controlling for smoking in the first 3 weeks of treatment, was used to evaluate the likelihood of abstinence at 6 weeks as a function of treatment assignment (active vs placebo) and adherence (ie, patch wear for >or=20 of the first 21 days of treatment). The relationship between reported adverse events and adherence was also examined. RESULTS: This analysis involved data from 371 subjects, 204 using the active patch and 167 using the placebo patch. The study population was mainly white (87.3%), had a mean age of 42.8 years, a mean weight of 77.3 kg, had been smoking for a mean of 24.4 years, and smoked a mean of 25.2 cigarettes per day. Two hundred fifty-three subjects were classified as adherent. Rates of adherence did not differ significantly between the active and placebo groups (139 [68.1%] and 114 [68.3%], respectively). The likelihood of experiencing an adverse event did not differ significantly between adherent and nonadherent subjects in either group. Among active patch users, 61.5% of nonadherent subjects experienced an adverse event, compared with 59.7% of adherent subjects; among placebo patch users, the corresponding proportions were 41.5% and 43.9%. Among active patch users, the odds of abstinence at 6 weeks were more than 3 times greater for adherent versus nonadherent subjects (53.2% vs 21.5%, respectively; adjusted odds ratio [OR] = 3.25; 95% CI, 1.30-8.09; P = 0.011); no benefit of adherence over nonadherence was seen among users of the placebo patch (16.7% vs 15.1%; adjusted OR = 0.60; 95% CI, 0.16-2.31). The interaction between treatment group and adherence was statistically significant (P = 0.022). CONCLUSION: Under conditions simulating over-the-counter use, adherence to daily nicotine patch wear within the first 3 weeks of treatment was associated with an improved likelihood of achieving smoking abstinence at 6 weeks.

Self-reported comorbidities among self-described overweight African-American and Hispanic adults in the United States: results of a national survey.

OBJECTIVE: To examine the concordance between self-described weight status and BMI, the prevalence of self-reported comorbidities, and the association between comorbidities and self-rated health among overweight African-American and Hispanic US adults. METHODS AND PROCEDURES: A nationally representative sample of 537 African-American and 526 Hispanic adults who were identified using a combination of random digit dialing and listed household sampling and self-described as being slightly or very overweight participated in a telephone interview. Self-reported height and weight were used to calculate BMI. RESULTS: More than half of African Americans (56%) and one-third of Hispanics (34%) who self-described as "slightly" overweight would be classified as obese based on BMI. One-third (33%) of African Americans reported high blood pressure, followed by arthritis (20%), high cholesterol (18%), and diabetes (15%). Among Hispanics, high cholesterol was the most frequently reported comorbidity (17%), followed by high blood pressure (15%), and difficulty sleeping (12%). Almost three-quarters of African Americans surveyed (72%) reported that their overall health was good to excellent compared to 62% for Hispanics. DISCUSSION: Self-reported rates of obesity-related comorbidities fall below what would be expected based on prevalence data derived from physiologic measures, suggesting a lack of awareness of actual risk. Despite the greater self-reported prevalence of certain risk factors for poor health, African Americans have a more optimistic view of their overall health and weight status compared to Hispanics. Physicians have an important opportunity to communicate to their minority patients the serious health consequences associated with excess weight.

Ten years after the Rx-to-OTC switch of nicotine replacement therapy: what have we learned about the benefits and risks of non-prescription availability?

OBJECTIVE: Review the history of the Rx-to-OTC switch of nicotine replacement therapy (NRT) in the US, outlining concerns expressed before the switch, discussing how concerns were addressed, and presenting data on the actual experience in the decade following the switch. METHODS: Literature review of studies examining trends in NRT utilization pre- and post-switch, the efficacy and safety of NRT in the OTC setting, and patterns of OTC NRT use. RESULTS: OTC availability of NRT increased access to and utilization of treatment. Studies show that OTC NRT has been used safely and effectively, without substantial misuse or abuse, and with continued physician engagement and wide access to proven behavioral treatment. CONCLUSIONS: With other medications that challenge the traditional OTC paradigm being proposed for OTC switch, the NRT case study serves as a useful example in highlighting the potential role that Rx-to-OTC switch can play in addressing public health challenges. The NRT experience suggests that advance identification and analysis of concerns, implementation of plans to manage concerns, including appropriate marketing and post-marketing surveillance, can ensure that OTC switch of medications for behavior change and disease prevention can help minimize risks and maximize public health benefits.

Offering free NRT through a tobacco quitline: impact on utilisation and quit rates.

OBJECTIVE: To assess the impact on quitline utilisation and cessation outcomes of adding free nicotine patches to the existing programme offerings. METHODS: Tobacco use status data from the Ohio tobacco quitline were collected from a subset of quitline callers 6 months after the initial intake call. To evaluate the impact of the nicotine replacement therapy (NRT) initiative, quit rates for two groups were compared: those who entered and exited the quitline programme before the availability of free NRT (n = 4657) and those who entered and exited the quitline programme after the availability of free NRT (n = 5715). RESULTS: Call volume increased from 2351 intakes calls per month or 78 calls per day before the availability of free NRT to 3606 intake calls per month or 188 intakes per day following the availability of free NRT (p<0.0001). 7-day point prevalence abstinence at 6 months among all quitline callers increased from 10.3% (95% confidence interval (CI) 9.7 to 10.9) before the availability of NRT to 14.9% (95% CI 14.3 to 15.5) after the availability of NRT. CONCLUSION: Offering free NRT through a state quitline is an effective means of increasing quitline utilisation and improving quit rates.

Tobacco cessation and weight loss: trends in media coverage.

OBJECTIVE: To examine time trends in amount of media coverage on tobacco cessation versus weight loss and test whether the 2 topics compete for limited media attention. METHODS: Monthly print and broadcast media coverage from 1995 to 2003 was estimated. RESULTS: Tobacco and weight coverage were uncorrelated. Tobacco coverage peaked in 1997-98, whereas coverage of weight increased linearly between 1995 and 2003. CONCLUSION: Tobacco and weight topics do not appear to compete for media coverage. Interest in weight topics is rising, consistent with its growing public health importance. Coverage of tobacco is declining, suggesting a need to keep tobacco and cessation in the public eye.

Non-medical use of OxyContin Tablets in the United States.

The non-medical use of OxyContin (controlled release oxycodone HCl) Tablets has been widely cited in media reports often leaving the impression that OxyContin was a source of primary or new onset drug abuse. However, no published research to date has examined the drug use history of those reporting non-medical use of OxyContin. This study examined rates of non-medical OxyContin use in the United States and the demographic and drug use profiles of those reporting such use, based on data from the 1999, 2000, and 2001 Substance Abuse and Mental Health Services Administration National Household Survey on Drug Abuse. Reported lifetime non-medical OxyContin use in the United States increased from 0.1% to 0.2% to 0.4% in 1999, 2000, and 2001 suggesting new incidence of 0.1%-0.2% per year. Compared to those reporting non-medical use of prescription analgesics other than OxyContin, non-medical OxyContin users were more likely to show a pattern of more serious drug abuse: they used multiple drugs, used needles for drug injection, and had higher rates of abuse and dependence. Approximately 83% of non-medical OxyContin users reported having used illicit drugs or other prescription medications non-medically prior to their first non-medical use of prescription analgesics. Even compared to those who reported non-medical use of other prescription analgesics, non-medical OxyContin users already had a more significant pattern of drug abuse before they began using prescription analgesics for non-medical purposes, suggesting that non-medical use of OxyContin is rarely the initiating factor leading to the abuse of other drugs.

Nicotine patch and lozenge are effective for women.

It has been hypothesized that women may be less likely to obtain therapeutic benefit from nicotine replacement therapy (NRT). The present study tested this hypothesis, using two different types of NRT medications. A secondary analysis of two randomized clinical trials was performed: One compared active 21-mg nicotine patch with placebo among 193 men and 309 women, and the other compared active 2-mg or 4-mg nicotine lozenge with placebo among 788 men and 1,030 women. Using logistic regression analysis of 6-month continuous abstinence and survival analysis, we assessed the efficacy of patch and lozenge among women and tested for a gender x treatment interaction. Active NRT was more effective than placebo among women, for both patch and lozenge. In the lozenge trial, women were less successful than men. The gender x treatment interaction was not significant in either study, whether assessed by logistic regression or survival analysis. In the lozenge trial, gender moderated the effects of smoking rate and dependence (but not treatment) on outcome: These variables affected success rates only among women. Treatment with nicotine patch or lozenge is effective for women, and the analysis did not reveal significant gender differences in efficacy. Gender differences in outcome may be moderated by nicotine dependence.

Patterns of over-the-counter nicotine gum use: persistent use and concurrent smoking.

AIMS: To examine the occurrence of persistent use (i.e. use beyond 12 weeks) and concurrent use of nicotine gum with cigarettes among consumers who purchase nicotine gum over-the-counter (OTC). DESIGN: Assessment of gum use was conducted in the context of a smoking cessation trial among smokers who purchased Nicorette gum and enrolled in the optional Committed Quitters smoking cessation program. Eligible participants were contacted by telephone 6 weeks and 12 weeks following their self-selected target quit date. Those who reported gum use at 12 weeks were contacted again at week 24. PARTICIPANTS: A total of 2655 current smokers who purchased nicotine gum and enrolled in a clinical efficacy trial of the Committed Quitters program. MEASUREMENTS: Detailed information on smoking and gum use, including frequency of use, amount used and reasons for use was obtained at each of the three follow-up assessments. FINDINGS: At the 24-week assessment, 6% of participants reported current use of nicotine gum (i.e. persistent use). Those engaging in persistent use averaged 4.7 (SD = 2.5) days of gum use per week and 3.2 (SD = 3.5) pieces of gum per day. Sixty-six per cent of persistent users reported at week 24 that they were not currently smoking, and 67% of persistent users reported they were using gum to establish or maintain abstinence. At the 6-, 12- and 24-week assessments, 14%, 10% and 2% of participants, respectively, reported current use of nicotine gum and current cigarette smoking (i.e. concurrent users). Those concurrent users reported at the 12-week follow-up that they did so an average of 4.4 (SD = 2.1) days per week, that they chewed an average of 2.6 (SD = 3.5) pieces of nicotine gum per day and that they smoked an average of 8.7 (SD = 8.6) cigarettes per day. CONCLUSION: Extended use of nicotine gum is rare. Concurrent use with cigarettes is uncommon. In both cases, the amount of gum use is small. OTC marketing of nicotine gum does not appear to have increased use contrary to labeling nor resulted in patterns of use that should warrant clinical or public health concerns.